Broader osteoporosis screening guideline drafted

Screening for osteoporosis should be conducted for all women 65 years and older and for younger women whose fracture risk is equal to or greater than that of a 65-year-old woman who has no additional risk factors, according to a US Preventive Services Task Force (USPSTF) recommendation statement draft. The proposed new USPSTF guideline would broaden the 2002 version, which recommended routine screening only for women 65 years and older and women aged 60 to 64 years who are at increased risk for osteoporotic fractures.

Highlights of the USPSTF draft guideline include the following:

•About 12 million Americans older than 50 years are expected to have osteoporosis by the year 2012; half of postmenopausal women will have an osteoporosis-related fracture during their lifetime.

•Convincing evidence suggests that bone measurement tests predict short-term risk of osteoporotic fractures in women and men; dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine and quantitative ultrasonography of the calcaneus are the most frequently used tests.

•The effect of screening for osteoporosis on fracture rates or fracture-related morbidity or mortality has not been evaluated in controlled studies.

•Convincing evidence indicates that drug therapies reduce the risk of fractures in postmenopausal women who have had no previous osteoporotic fractures.

•The choice of therapy to reduce fractures should be an individual one based on the patient's clinical situation and the trade-off between benefits and harms; clinicians should provide patient education on how to use drug therapies to minimize adverse effects.

•Current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. In deciding whether to refer men for screening, clinicians should consider the potential preventable burden, potential harms, current practice, and costs.

•No new studies have described harms of screening for osteoporosis in men or women.

•For women 65 years and older and for younger women whose fracture risk is equal to or greater than that of a 65-year-old woman who has no additional risk factors, there is moderate certainty that the net benefit of screening for osteoporosis using DXA is at least moderate.

•Clinicians should take into account remaining life span when deciding whether to screen patients who have significant morbidity.

•The quantity and quality of data on osteoporotic fracture risk other than hip fracture are much lower for Asian, American Indian/Alaska Native, Hispanic, and African American women than for white women.

•The potential value of rescreening women who were not found to have osteoporosis with an initial screening test is improvement of fracture risk prediction.

•Further research that would provide information for clinical decisions about screening for osteoporosis include studies that establish parameters for treatment using quantitative ultrasonography as a primary screening test for osteoporosis, ascertain the true incidence of major osteoporotic fractures in nonwhite ethnic groups in the United States, clarify optimal screening intervals, and evaluate the impact of clinical and subclinical vertebral fractures on health-related quality of life.

The USPSTF osteoporosis screening draft, based on a review of evidence published recently in the Annals of Internal Medicine, was sponsored by the Agency for Healthcare Research and Quality (AHRQ) in the US Department of Health & Human Services. The draft was to be available for comment on the AHRQ's Web site for 4 weeks, through August 3, 2010; recommendations may be changed on the basis of comments. For more information, visit the site at http://www.ahrq.gov.